The concept of self-management of type 1 diabetes in children and adolescents: an evolutionary concept analysis

AIM: An evolutionary concept analysis was undertaken to clarify the concept of self-management of type 1 diabetes in children and adolescents. BACKGROUND: Several problems exist in the literature on self-management of type 1 diabetes in children and adolescents. There is no uniform terminology and there is no uniform definition of the concept. Also, there is no differentiation in the literature between self-management of diabetes in children and adults. METHODS: Ninety-nine references were reviewed and analysed in the disciplines of nursing, medicine, and psychology. After separate analyses revealed no significant differences across disciplines, the analyses were combined to describe the attributes, antecedents, consequences, and surrogate and related concepts. RESULTS: The three essential attributes of the concept were identified as process, activities, and goals. Self-management of type 1 diabetes in children and adolescents is an active and proactive process; it is daily, lifelong, and flexible, and it involves shifting and shared responsibility for diabetes care tasks and decision-making between child and parent. It is a process that involves collaboration with health care providers. Self-management of type 1 diabetes in children and adolescents also consists of varied and many activities related to giving insulin, monitoring metabolic control, regulating diet and exercise, to name just a few. The concept also involves goals, which may differ from one parent/child dyad to another. A working definition of the concept is suggested. CONCLUSIONS: It is hoped that a more uniform definition of the concept will enable researchers to continue investigating antecedents and consequences of the concept in a way that allows for aggregating results.     

Psychological distress: concept analysis

BACKGROUND: The term 'distress' is frequently used in nursing literature to describe patient discomfort related to signs and symptoms of acute or chronic illness, pre- or post-treatment anxiety or compromised status of fetuses or the respiratory system. 'Psychological distress' may more accurately describe the patient condition to which nurses respond than does the term 'distress'. Psychological distress is seldom defined as a distinct concept and is often embedded in the context of strain, stress and distress. This creates confusion for nurses attempting to manage the care of people experiencing psychological distress. AIMS: This paper is a concept analysis of psychological distress based on Walker and Avant's (1995) criteria that identifies the attributes, antecedents, and consequences of psychological distress based upon the findings of the literature review. In addition, empirical references are identified and constructed cases presented. METHODS: A literature search was conducted using MEDLINE, CINAHL, Ovid, PsychINFO, and Cancer Lit databases over the last 50 years. The purposes of this concept analysis were: (1) to establish the concept of psychological distress as a clear and distinct concept, separate from strain, stress and distress, and (2) to provide nurses with a base of knowledge from which to plan effective clinical interventions. FINDINGS: Content analysis of the literature revealed that, although used frequently in health care literature, the origin of the concept of psychological distress has not been clearly articulated and is ill-defined. CONCLUSIONS: Psychological distress is a serious problem faced by many of the people whom nurses encounter on a daily basis. An understanding of the concept of psychological distress will help nurses ameliorate this problem in patients. Nursing research related to the exploration of psychological distress is also needed.     

唇腭裂患儿父母心理状况研究现状

介绍了唇腭裂患儿父母心理健康状况及其对患儿的影响,并阐述了影响唇腭裂患儿父母的心理因素及心理干预措施。     

自我管理教育对哮喘患儿父母生活质量和心理压力的影响

目的探讨自我管理教育对哮喘患儿父母生活质量和心理压力的影响。方法对48名哮喘患儿父母进行为期1年的自我管理教育干预,干预前后采用生活质量综合评定问卷-74(generic quality of life inventory-74,GQOLI-74)和患病患儿父母心理压力问卷进行测评。结果干预后患儿父母个人和家庭、经济负担、终生照顾、缺乏成就感、过度保护及压力总体得分较干预前降低;患儿父母GQOLI-74中4个维度及其20个因子得分均较干预前高,干预前后比较,差异具有统计学意义(均P0.05或P0.01)。结论自我管理教育能降低患儿父母的心理压力,提高其生活质量。     

糖尿病患者心理痛苦与应对方式及授权能力的相关性研究

目的调查糖尿病患者心理痛苦与应对方式、授权能力的相关性。方法采用糖尿病痛苦量表、应对方式量表、糖尿病授权简化量表对211例糖尿病患者进行问卷调查。结果糖尿病患者心理痛苦总分为(39.46±16.66)分,21.33%的患者处于中度或以上痛苦;消极应对评分低于常模(P0.01);糖尿病授权能力总分为(4.22±0.70)分。生活规律相关的痛苦与消极应对呈正相关(r=0.106,P0.05);人际关系相关的痛苦与授权能力呈负相关(r=-0.118,P0.05)。结论糖尿病患者心理痛苦与消极应对、授权能力之间有相关性,良好的心理状况能积极应对疾病,形成理想的授权能力,进一步提高糖尿病患者的自我管理能力。     

Examining pain-related distress in relation to pain intensity and psychological distress

Despite frequent use of the term symptom distress in the pain literature, symptom distress is often confused with symptom intensity and psychological distress, contributing to inadequate assessment of symptoms and less than ideal symptom management. In this article we address these issues and propose a hybrid model, combining Price's interaction of pain sensation, pain unpleasantness, and secondary pain affect model with an information processing model. Recommendations on methods and techniques to reduce this confusion would assist healthcare professionals and researchers to better distinguish among these terms as they manage patient symptoms and design symptom management studies. Thus, the purpose of this article is to examine the terms symptom distress, symptom intensity, and psychological distress using pain as the example symptom.     

Chronic sorrow in parents of children with type 1 diabetes

Title.  Chronic sorrow in parents of children with type 1 diabetes.
Aim.  This paper reports on a study exploring parents' longer-term experiences of having a child with type 1 diabetes.
Background.  Parents of children with type 1 diabetes may experience a grief reaction at diagnosis similar to that normally associated with bereavement, but little is known about their long-term emotional adaptation. Chronic sorrow, a sustained but intermittent grief reaction, is identified in adults with diabetes but has not previously been explored in relation to parents.
Methodology.  In-depth interviews were conducted in 2007 with a convenience sample of 17 parents of children with type 1 diabetes 7–10 years after diagnosis. Data were explored within a theoretical framework of grief, loss, adaptation, and change.
Findings.  Parents had adapted to the needs of diabetes management but most had not 'come to terms' with the diagnosis. They experienced a resurgence of grief at critical times during their child's development and some, particularly mothers, became upset during their interviews, even though these took place 7–10 years after their child's diagnosis. Mothers elaborated more on their emotions than fathers, but continuing feelings associated with grief, such as anger and guilt, were expressed by both fathers and mothers.
Conclusion.  Greater understanding of parents' long-term emotional responses and recognition that grief may never resolve in these parents may enable healthcare professionals to provide appropriate and timely support at critical times.     

Ⅰ型糖尿病儿童和青少年心理应激应对的研究进展

本文通过文献回顾,探讨了Ⅰ型糖尿病儿童和青少年的心理应激状况及心理应激的应对方式,可以根据影响心理应激应对的因素进行针对性指导,以帮助其采取更合理的应对方式.     

颅脑外伤患儿家属的生活变化单位与家属心理状态关系的研究

[目的]探讨颅脑外伤患儿家属的生活变化单位与家属心理状态关系,为向患儿家属进行有效护理干预提供依据。[方法]应用霍尔姆斯和雷赫的社会再适应评定量表和症状自评量表(SCL-90)调查335名颅脑外伤患儿家属的生活变化单位(LCU)得分和心理状态。[结果]颅脑外伤患儿家属LCU得分高于平诊患儿家属LCU得分(对照组);患儿家属的SCL-90各因中人际关系、抑郁、焦虑3个因子分值高于国内常模;患儿LCU得分高,SCL-90总分也高。[结论]小儿颅脑外伤是一种严重的突发不可控制事件,护士应了解患儿家属家庭状况及家属心理状态,有针对性地对家属进行健康教育和心理干预,提高家庭应激支持水平。